Enhancing the body, negotiating identity: A phenomenological study of athletic, feminine, and moral identity among women who use performance and image-enhancing drugs (PIEDs)

BACKGROUND: Performance and image-enhancing drug (PIED) use has historically been shaped by masculine norms, emerging from bodybuilding cultures that prioritise size, strength, and control. While the number of women engaging with PIEDs is increasing, their experiences remain under-researched. This study examines how women who use PIEDs make sense of and negotiate enhancement practices in relation to intersecting athletic, feminine, and moral identities within gendered enhancement environments. METHODS: We conducted an interpretative phenomenological analysis (IPA), with synthesis informed by a social identity lens. Nine women engaged in weight-training and current or past PIED use participated in 1-2 semi-structured interviews. Transcripts were thematically analysed to explore how participants made sense of their enhancement practices in relation to athletic, feminine, and moral identities. FINDINGS: Participants described using PIEDs strategically to achieve competitive goals while managing expectations around femininity and moral responsibility. A central insight from the study is the nuanced relationship between being 'responsible' in PIED use and broader sociocultural expectations on women to demonstrate control, restraint, and moral legitimacy. These dynamics intensified the balancing act participants described between competitive success, bodily autonomy, and social acceptability. CONCLUSION: These insights contribute to a deeper understanding of women's PIED use and identity pressures in fitness subcultures. They also highlight the need for tailored, gender-sensitive harm-reduction approaches, educational and clinical resources that recognise women's situated knowledge and address the unique challenges they face in these contexts.